BACKGROUND:China has made substantial efforts aimed to promote the uptake of antiviral treatment of hepatitis B (HB). It is unclear whether these policies achieved the desired impact. This study adopted medicines procurement data from 31 provinces to generate the first evidence about the number of standard antiviral treatment of HB overtime at both national and provincial levels in China. METHODS:We performed the panel data analyses and quasi-experimental design with the time-varying difference-in-difference method combined with the event study approach to estimate the uptake of HB antiviral treatment before and after national policy changes. RESULTS:The overall trends in HB antiviral treatment at the national level increased incrementally during 2013-2020. There was 2.8862 million 12-month (person-year) antiviral standard treatment in 2020, which was only 8.93% of the eligible people estimated to need treatment. The number of monthly antiviral standard treatment increased by 42.4% (p = .001) overall following the nationwide adoption of the '4 + 7' pilot-pooled procurement prices in 2019, which brought substantial price reduction of core antivirals. CONCLUSIONS:A low treatment rate is a critical issue in reaching the elimination of viral hepatitis as a public health threat in China. Affordability is an important but not the only factor that determines the uptake of hepatitis treatment. Further scaling up and acceleration of treatment uptake will need strategies improving public awareness of HB, strengthening diagnosis, linking people who are infected to chronic care, reducing loss to follow-up, and ensuring people who are eligible get timely treatment.

[目的]了解我国30家妇幼医院门诊患者的满意度及其影响因素,为改善医疗服务提出意见和建议.[方法]基于"全国进一步改善医疗服务行动计划第三方评估"(2017-2018),对全国30个省、自治区、直辖市(不包括西藏自治区)的30家省三级妇幼医院的门诊患者满意度进行调查,利用SPSS 24.0软件,采用χ2检验、二分类多因素Logistic回归方法,对门诊患者满意度的影响因素进行分析.[结果]门诊患者的总体满意度为88.2％.其中,"窗口挂号排队等待时间"(68.3％)"候诊时间"(63.2％)的满意度较低,"我的个人隐私受到了保护"(91.8％)满意度较高.多因素分析显示,"就诊前是否有固定医生""挂号排队等待时间""就诊时与医生的沟通时间""接诊医生的医术""医护人员耐心讲解治疗方案、用药方法及注意事项""遇到问题时有工作人员及时解答和引导"是影响妇幼医院门诊患者就医总体满意度的因素(P<0.05).[结论]患者对妇幼医院门诊就医的总体满意度较高,"医护人员医术"及"医护人员耐心讲解治疗方案、用药方案及注意事项"是影响总体满意度的主要因素.优化就诊流程,缓解"三长一短"现状、提升医疗技术及质量、改进并完善非医疗技术服务是增加优质医疗供给,提升患者满意度的关键.

Background: Tense doctor–patient relationships have become a great challenge for the Chinese government due to their high incidence rate and negative social impact. This study aimed at exploring the factors influencing doctors’ perceptions of the doctor–patient relationship. Methods: We conducted a national cross-sectional study in 136 tertiary grade-A hospitals in China. A total of 19,774 doctors reported their perceptions of the doctor–patient relationship over the last two years, as well as sociodemographic factors, work experience, and hospital security measures. A logistic-regression model was used to identify factors significantly associated with doctors’ perceptions of the doctor–patient relationship. Results: Doctors’ perceptions of the doctor–patient relationship were relatively negative. Region, hospital type, gender, age, and income influenced these perceptions. With regard to doctors' work experience, those with excessive workloads, those who had experienced medical disputes, and those who did not have enough communication time with patients tended to report more-negative perceptions of the doctor–patient relationship. In terms of hospital security measures, doctors working in hospitals with effective precautions, in-place security staff, and medical-liability insurance purchased for medical staff tended to report more-positive perceptions of this relationship. Conclusion: Doctors’ work experiences and hospital security measures both played essential roles in improving doctors' perceptions of the doctor–patient relationship. On the part of doctors, improving their communication skills and providing adequate communication were beneficial to their perceived relationships with patients. On the part of hospitals, reducing doctors’ workloads, preventing medical disputes, and increasing job security and organizational support are potential ways to improve doctors' perceptions of these relationships. Practice implications： This study provided evidence and advice for Chinese government, as well as Chinese hospitals, to improve doctors’ perceptions of the doctor-patient relationship by measures of enhancing doctors’ work experiences and hospital security.

To systematically compare the efficacy and safety of sufentanil versus fentanyl for pain relief in labor involving combined spinal-epidural analgesia (CSEA), a systematic review and meta-analysis of randomized controlled trials targeting parturients requesting labor analgesia was conducted. The primary outcome measure was visual analog scale scores assessed at 10, 15, 30, and 60 min after intrathecal injection. Secondary outcomes included duration of spinal analgesia, incidence of side effects in parturients, and neonatal Apgar scores. Twelve randomized controlled trials, including data from 881 patients fulfilled the inclusion criteria. No clinically meaningful differences in pain reduction after intrathecal injection were found between the two analgesics. Sufentanil extended the duration of spinal analgesia by 25.40 min (95% CI 21.82 to 28.98 min; p < 0.00001) compared with fentanyl. The risk for pruritus, nausea, and vomiting among parturients was 82% for those using sufentanil (relative risk 0.82 [95% CI 0.67–0.99]; p = 0.04) and 48% for those using fentanyl (relative risk 0.48 [95% CI 0.29–0.80]; p = 0.005). Both the synthesis results and sensitivity analysis demonstrated no differences in the risk for respiratory depression between parturients using sufentanil versus fentanyl. The neonates in sufentanil group exhibited higher Apgar scores than the fentanyl group 5 min after delivery (weighted mean difference 0.10 [95% CI 0.05–0.16]; p = 0.0002). Existing evidence suggests that compared with fentanyl, sufentanil used for analgesia in combined spinal-epidural during labor is more effective in extending the duration of spinal analgesia, and may be safer for the infant. There was overall low clinical and statistical heterogeneity among the included studies. For all outcomes, variations caused by heterogeneity across trials were acceptable. Thus the findings of this meta-analysis may provide additional evidence for future clinical practices of pain relief in labor involving CSEA. Stronger evidence supporting this conclusion will require data from more high-quality and multicenter randomized controlled trials.

目的:总结全国"进一步改善医疗服务行动计划"落实情况,分析住院患者就医体验的改善进展、成效和仍存在的问题,为下一步改善医疗服务行动提供参考.方法:基于全国"进一步改善医疗服务行动计划"2016—2019年连续四次的第三方评估之住院患者调查结果,对相同指标调查结果进行比较和描述性分析.结果:住院患者平均等待入院时长为3天,绝大多数是本院直接收治,出院去向是回家;住院患者总体满意度较高,高于门诊患者满意度,对诊疗服务和护理服务的满意度连续四年高于对就医流程和住院环境的体验;改善医疗服务成效最大的是患者向医院反映有关问题的渠道更加通畅和让患者对住院费用的理解更加明晰,改善成效相对较小的是入院手续和出院流程及医院膳食质量.结论:下一步针对住院服务的改善行动应重视就医流程和医院膳食等非技术性服务.

目的 系统评价氢吗啡酮与吗啡用于剖官产术后镇痛治疗的有效性和安全性.方法 计算机检索The Cochrane Central Register of Controlled Trials (CENTRAL)、PubMed、EMbase、CNKI、WanFang Data、VIP和SinoMed等数据库,搜集比较氢吗啡酮与吗啡应用于剖官产术后镇痛的随机对照试验(RCT),检索时限均为建库至2017年12月.由2名评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.3软件进行meta分析.结果 共纳入7个RCT,共586例剖官产术后产妇.meta分析结果显示:氢吗啡酮组术后硬膜外镇痛泵给药6 h[MD=-0.23,95％CI(-0.38,-0.08),P=0.003]、12 h [MD=-0.56,95％CI(-1.10,-0.02),P=0.04]、24h[MD=-0.37,95％CI(-0.65,-0.09),P=0.01]和48 h[MD=-0.41,95％CI(-0.74,-0.08),P=0.01]的疼痛视觉模拟评分(VAS)均低于与吗啡组.但两组在各时点Ramsay镇静评分的差异均无统计学意义.不良反应方面,氢吗啡酮组的瘙痒发生率[RR=0.27,95％CI (0.09,0.81),P=0.02]和呕吐发生率[RR=0.15,95％CI (0.03,0.65),P=0.01]均低于吗啡组,其差异均有统计学意义.结论 现有证据表明,氢吗啡酮与吗啡相比,在剖宫产术后镇痛方面可能疗效更佳,且能够有效减少产妇的皮肤瘙痒及呕吐的不良反应.受纳入研究质量和数量的限制,上述结论尚待开展更多高质量研究予以验证.

Objective To study patient satisfaction at tertiary hospitals in China, and explore the influence of such factors as sociodemographic and institutional characteristics on the their satisfaction. Methods Based on the third round third party evaluation of China Healthcare Improvement Initiative(the Initiative), a patient satisfaction survey was made from December 2017 to January 2018 at 136 public tertiary hospitals across the country.Chi-square test and binary multivariate logistic regression methods were used to identify influencing factors for patient satisfaction. Results Patient satisfaction varies significantly among hospitals of different types, regions and institution affiliations.Satisfaction of outpatients at their local hospitals was 1.395 times higher than those hospitals under the National Health Commission, and that of inpatients at the central regions was 1.352 times higher than those of the eastern region.Gender, department, education level, medical insurance, patient source and registration method were significant influencing factors for overall satisfaction of outpatients(P<0.05); Region, department and occupation were significant influencing factors of overall satisfaction of inpatients(P<0.05). Conclusions The allocation of medical resources should consider hospital type and region.The affordability of medical expenses and fairness of medical insurance system deserve more attention.The satisfaction of women and children patients should be improved by providing high-quality and humane medical and nursing care. Key words: Patient satisfaction; Outpatients; Inpatients; Influencing factors; Third party evaluation

BackgroundLittle information is available on the need for opioid analgesics based on demographic, economic and disease spectrum data, or on patient affordability of opioid analgesics, in different regions of China. This study analysed the level of, and trends in, opioid analgesic use in different regions of China from 2006 to 2016, calculated the need for opioid analgesics based on demographic, economic and disease spectrum data from the different regions, and analysed the gap between need and actual consumption. Patient affordability of opioid analgesics for cancer pain management was also measured.MethodsOpioid analgesic consumption data were obtained from the China Hospital Pharmaceutical Audit (CHPA) database of IQVIA (formerly Quintiles and IMS Health). We assessed the clinical need for opioid analgesics by calculating the morphine use density (MUD, daily defined doses of morphine per 100 000 population) and its growth rate from 2006 to 2016 in China and its seven regions. Regional need for opioid analgesics (in morphine equivalents) was estimated based on regional cancer registration data and standard treatment doses of opioids, as defined by international guidelines for cancer pain management. The study adopts WHO and Health Action International (HAI) methods to evaluate patient affordability of opioid analgesics for cancer pain management using standardized costs in daily defined doses (DDD).FindingsThe national MUD increased from 1·45 DDD/100 000/day in 2006 to 6·93 DDD/100 000/day in 2016. Southern China had the highest MUD (9·67 DDD/100 000/day), and northwest China had the lowest MUD (3·28 DDD/100 000/day) in 2016. The actual use of morphine equivalents accounted for only 21·5% of the morphine required for cancer pain management at the national level; 26% in east, 36% in south, 11% in southwest, and 12% in northwest China. The DDD costs of all studied opioid analgesics ranged from CNY ¥10·80 to ¥848·88. Except for morphine injections, the out-of-pocket payments for a standard full course of treatment with opioid analgesics were more than the daily disposable income in all regions. Patient affordability of opioid analgesics is low according to the WHO and HAI method.InterpretationOpioid analgesic use for the management of cancer pain was insufficient relative to needs in China, and varied markedly across regions with different levels of economic development. Long-term use may pose a heavy economic burden to patients. The findings call for actions to strengthen cancer pain management, and to improve the affordability of drugs.FundingThe Peking Union Medical College Education Fund.

Objectives China launched the National Healthcare Improvement Initiative (NHII) in 2015 to improve patient experiences in healthcare. This study aimed to generate evidence of hospital care quality from the patients’ perspective. Design This nationwide cross-sectional study interviewed participants from 31 provinces, municipalities and autonomous regions across China. Setting A total of 117 tertiary hospitals in mainland China. Participants 48 422 responses from outpatients and 35 957 responses from inpatients were included in this study. Primary outcome measure The scores of six predefined domains in the Chinese Patient Experience Questionnaire, five of which were designed to reflect specific dimensions of care, and one of which indicated the overall rating. Results More than 80% of the respondents viewed their care experiences as positive. The NHII seems to have had a positive impact, as indicated by the steady, although unremarkable, increase in the patient experience scores over the 2016–2018 period. The Chinese patients generally reported a positive experience with the clinical aspects of care, but reported a less positive experience with the environmental, interpersonal and social services aspects of care. The institutional factors, including region and type of hospital, and personal factors, such as gender, age, education and occupation, were factors affecting the patient experience in China. Humanistic care was the aspect of care with the greatest association with the overall patient experience rating in both the outpatient and inpatient settings. Conclusions The national survey indicated an overall positive patient perspective of care in China. Older age, higher education level and formal employment status were found to be correlated with positive care experiences, as were higher levels of economic development of the region, a more generous insurance benefits package and a higher degree of coordinated care. The interpersonal-related initiatives had substantial roles in the improvement of the patient experience. In the regions where farmers and users of traditional Chinese medicine services constitute a greater proportion of the population, improvement of patient experiences for these groups deserves special policy attention.

目的 系统评价舒芬太尼与芬太尼用于剖宫产术后静脉自控镇痛的有效性和安全性.方法 计算机检索MEDLINE (OVID)、Web of Science、The Cochrane Central Register of Controlled Trials (CENTRAL)、PubMed、EMbase、CNKI、WanFang Data、VIP和SinoMed数据库,搜集舒芬太尼与芬太尼用于剖宫产术后自控静脉镇痛的随机对照研究(RCT),检索时限均从建库至2018年4月1日.由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan 5.1软件进行Meta分析.结果 共纳入19个研究,共包含2 834例受试者,其中舒芬太尼组1 417例,芬太尼组1 417例.Meta分析结果显示:与芬太尼组相比,舒芬太尼组可降低术后4 h[MD=-0.99,95％CI(-1.03,-0.95),P＜0.001]、8 h[MD=-0.30,95％CI(-0.40,-0.21),P＜0.001]、12h[MD=-0.54,95％CI (-0.62,-0.46),P＜0.001]和24 h[MD=-0.35,95％CI(-0.41,-0.28),P＜0.001]的VAS评分;在提高4 h[MD=0.72,95％CI (0.66,0.78),P＜0.001]、8 h[MD=0.93,95％CI (0.86,1.00),P＜0.001]、12 h[MD=0.98,95％CI (0.91,1.05),P＜0.001]、24 h[MD=0.07,95％CI (0.03,0.11),P=0.000 5]和48 h[MD=0.05,95％CI (0.03,0.08),P＜0.000 1]Ramsay镇静评分方面差异均有统计学意义.不良反应方面,舒芬太尼组发生恶心呕吐[RR=0.25,95％CI (0.19,0.31),P＜0.001]、皮肤瘙痒[RR=0.41,95％CI (0.30,0.57),P＜0.001]、头晕[RR=0.27,95％CI (0.17,0.44),P＜0.001]及尿潴留[RR=0.35,95％CI(0.1 5,0.82),P=0.02]的风险低于芬太尼组.结论 现有证据表明,舒芬太尼用于剖宫产术后自控静脉镇痛能获得比芬太尼更好的镇痛和镇静效果,并能降低部分术后不良发应发生率,临床应用更安全.

China's increasing attention to patient satisfaction evaluation is part of an international trend of patient-centered healthcare. Patient sociodemographic characteristics are important intrinsic factors that will influence satisfaction. This paper aims to better understand how sociodemographic factors affect Chinese patient satisfaction with tertiary outpatient services using data from the 2017 China National Patient Survey. A total of 28,760 outpatient survey responses were analyzed, spanning 136 tertiary hospitals across 31 provinces. Multilevel logistic regression with fixed hospital effects was used to examine the association of patient satisfaction across multiple healthcare domains with sociodemographic factors. Results show that patients who were of a migrant population, of highest income, most educated, and who had medical aid insurance reported the lowest levels of overall satisfaction. Specifically, increasing age was correlated with decreased satisfaction in process management and affordability domains, while high-income and high-education outpatients reported lower satisfaction scores in the hospital environment domain. Furthermore, migrant patients experienced lower satisfaction across several domains. These intricate findings suggest that hospitals should tailor their services and evaluation metrics to specific patient demographics, and that the government should adopt policies that reduce disparities in healthcare access and affordability to ultimately improve the satisfaction of vulnerable groups.

AbstractBackgroundPatient satisfaction has been seen as a key criterion when evaluating hospitals and is one of the main focuses of the current health‐care reform in China. This paper aimed to explore patient‐ and hospital‐level factors associated with inpatient satisfaction, which can provide policy implications for the evaluation and development of a patient‐oriented health‐care system.MethodsThe paper analyses data from the 2017 China National Patient Survey which includes 20 300 inpatients from 131 tertiary hospitals across 31 provinces. Descriptive analysis and multivariable logistic regressions are conducted to identify key factors related to satisfaction.ResultsPatient sociodemographic characteristics, including gender, age, income and insurance type, are found to be strongly associated with their satisfaction of inpatient experience. In terms of institutional characteristics, hospital type, size, staffing and financial performance are also significantly correlated with inpatient satisfaction. Patients are more satisfied with specialist hospitals and large hospitals measured by the number of beds and surgeries. Hospitals with higher nurse‐to‐bed ratio also receive more satisfaction. The financial performance of hospitals, however, is negatively associated with satisfaction.ConclusionPatient satisfaction contains unique information on service quality and thus should be incorporated into the matrix of hospital evaluation. Meanwhile, differences in patient composition must be adjusted to make fair comparisons across hospitals. Moreover, future reform needs to put greater efforts in the design of comprehensive public insurance scheme, efficient hospital structure and an overall well‐functioning health‐care delivery system in order to better serve patients in China.

Public hospitals are integral components of China's health care system, and improving quality of care and patient satisfaction has become of greater concern for these hospitals. The aim of this study was to assess outpatient satisfaction with tertiary hospitals and to explore the roles played by patient perceptions of specific aspects of care in overall satisfaction. We designed a questionnaire to assess patient satisfaction and perceived quality of care using a 5-point Likert scale. The survey was conducted in 136 hospitals across 31 provinces of China, and a total of 28 822 patients were interviewed. For statistical analysis, we conducted descriptive analysis, nonparameter tests, Spearman's rank correlation, and multivariate logistic regression. Stepwise logistic regression identified 12 variables of patient perception associated with overall satisfaction. Patients' perception of physicians' technical skills had the strongest association with satisfaction, followed by inquiries into medical history/current situation and availability of elevators. Other determinants included a feeling of respect, timely guidance when needed, and explanation of treatments and medications. Waiting times and hospital environment factors, such as cleanliness of bathrooms and drinking water supply, were also associated with patient satisfaction in a slightly less powerful way. This study revealed that Chinese outpatient satisfaction with tertiary hospitals was relatively high. As determinants of satisfaction, patients valued professional medical care and respect from the medical staff more than nonmedical aspects of care. This implied that Chinese hospitals should ensure quality of medical care and sufficient communication with patients, as well as pay more attention to humanism in health care. In the meantime, improvements should be made to nonmedical aspects of care, especially waiting times and physical environment. These findings are also useful for the rest of the low- and middle-income world in improving patient satisfaction.

Study on the influencing factors for patient satisfaction at tertiary hospitals in China [Abstract] Objective To study patient satisfaction at tertiary hospitals in China, and explore the influence of such factors as sociodemographic and institutional characteristics on the their satisfaction. Methods Based on the third round third party evaluation of China Healthcare Improvement Initiative( the Initiative), a patient satisfaction survey was made from December 2017 to January 2018 at 136 public tertiary hospitals across the country.Chi-square test and binary multivariate logistic regression methods were used to identify influencing factors for patient satisfaction.Results Patient satisfaction varies significantly among hospitals of different types, regions and institution affiliations.Satisfaction of outpatients at their local hospitals was 1.395 times higher than those hospitals under the National Health Commission, and that of inpatients at the central regions was 1.352 times higher than those of the eastern region. Gender, department, education level, medical insurance, patient source and registration method were significant influencing factors for overall satisfaction of outpatients ( P <0.05 ); Region, department and occupation were significant influencing factors of overall satisfaction of inpatients ( P < 0.05 ). Conclusions The allocation of medical resources should consider hospital type and region.The affordability of medical expenses and fairness of medical insurance system deserve more attention. The satisfaction of women and children patients should be improved by providing high-quality and humane medical and nursing care.

Context. The annual consumption of opioid analgesics in the U.S. was more than 10 times the world average, whereas that in China was at a moderate level within Asia but much lower than the worldwide average. The opposite situations of opioid use in the U.S. and China revealed totally different problems in the developed versus developing world, that is, overuse versus underuse of opioids. Objectives. This study analyzed the clinical consumption, estimated the needs of pain treatment, and evaluated the adequacy of opioid analgesic consumption in mainland China and its seven regions. Methods. A retrospective analysis of the national and regional consumption of opioid analgesics in mainland China during 2006-2016 was conducted. The adequacy of consumption measure was used to gauge the overall adequacy of opioid analgesic consumption in morphine equivalents (MEs) for the treatment of moderate-to-severe pain in mainland China and compared with international data. Annual per capita consumption was adopted to measure the clinical consumption of opioid analgesics in MEs at a national level and across seven regions of mainland China. Needs of morphine for cancer pain treatment in mainland China and in its seven regions were estimated and compared with the clinical consumption of opioid analgesics in MEs. Results. The adequacy of consumption measure of mainland China ranged from 0.0041 to 0.0088 during 2006-2016, which was less than 1% of that in the reference countries. The poor North East region had only 10.85% of the cancer pain morphine needs fulfilled. The highest fulfillment rate was 36.02% in rich Southern China, which was 25.9% at the national level. Conclusion. The clinical consumption of opioid analgesics for the treatment of moderate-to-severe pain in mainland China was far below the international level. The annual per capita of clinical consumption was lower, and the adequacy of cancer pain treatment was poorer in less developed areas. All these findings call for actions to strengthen pain management. (C) 2019 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Objective To learn the current situation and influencing factors of outpatients′perceptions of doctor-patient relationship,and to generate evidence for effective improvement of outpatients′perceptions of doctor-patient relationship.Methods Based on the results of the third party evaluation of the National Healthcare Improvement Initiative(2016-2017)in 136 hospitals, we analyzed the outpatients′perceptions of doctor-patient relationship and its influencing factors.Univariate analysis of the outpatients′perceptions of doctor-patient relationship(Chi-square test and Wilcoxon rank sum test),and binary logistic regression were conducted to analyze the influencing factors of the outpatients′perceptions of doctor-patient relationship.Results A total of 29 105 out-patients were included in this study.The average outpatient perception score of doctor-patient relationship was 3.88 ±0.99, and the median was 4.00.The perception score of outpatients pertaining to doctor-patient relationship was the highest in the eastern regions and lowest in the western regions.That of outpatients from general hospitals was highest than that of those in maternal and child hospitals and traditional Chinese medicine hospitals.Patients′waiting time for consultation,having a fixed physician or general practitioner before visiting, contracting with a community doctor or not, the overall satisfaction,and the household income and insurance coverage were all the influencing factors of the outpatients′perceptions of doctor-patient relationship(P<0.05).Conclusions There is still a long way to go before the patients can agree with the perception of a better doctor-patient relationship.The critical points for improvement include reducing waiting time for consultation, allocation of more medical resources to the western regions,improving humane care to patients and raising outpatients′overall satisfactions, especially in the departments of obstetrics and gynecology,and pediatrics.

Objective To analyze the differences and influencing factors of inpatient satisfaction on hospitals of different types in different regions two years following implementation of the National Healthcare Improvement Initiative.Methods Data of hospitals and inpatient satisfaction survey results were collected from the a third-party evaluation of the National Healthcare Improvement Initiative, and analyzed in a two-step clustering model.This effort aims at learning the subjective feelings of inpatients and impacts of the objective indicators of medical resources allocation on inpatient satisfaction.The analysis helps identify indicators to be included into the clustering model and their correlation with such satisfaction.Results The two-step clustering rounded hospitals into four categories based on the inpatient overall satisfaction.Gaps were found among different categories of hospitals in terms of types of hospitals, location, affiliation and healthcare resources allocation.The inpatient overall satisfaction varied with these indictors.Among the category with the highest inpatient overall satisfaction, 100% were general hospitals, most of which in eastern area(52.38%),and local hospitals(50.00%).Hospitals in this category feature larger scales and stronger medical techniques.The category with the lowest inpatient overall satisfaction were mostly hospitals located in western regions(65.52%), maternal and child hospitals(41.38%)and local hospitals (89.65%).Most of these hospitals were large in scale, but their medical techniques and resources fell behind their eastern counterparts.The strongest correlation with inpatient overall satisfaction was medical behavior(r=0.95), while the weakest was the medical resources allocation(r<0.30).Conclusions There are gaps of inpatient overall satisfactions among different types of hospitals located in different regions. Patients′subjective perceptions and medical resources allocation affected their overall satisfactions.The non-medical services were important factors towards patient satisfaction.

目的:了解我国阿片类镇痛药物使用现况及变化趋势,及阿片类镇痛药物治疗中、重度疼痛的消耗充分性水平.方法:采用回顾性分析方法,分析2006 ～2016年我国阿片类镇痛药物的消耗频度(DDDs)及变化趋势;采用计算消耗量充足性测量(ACM)的方法测算我国全人群中、重度疼痛吗啡治疗需要量,评价我国阿片类镇痛药物治疗中、重度疼痛的消耗充分性,并与其他国家和地区进行横向比较.结果:2006～2016年,我国阿片类镇痛药物消耗频度(DDDs)从9.7亿DDDs增加到37.03亿DDDs,增速先快后缓,尤以2013年增长较为明显,2015年稍有下降.基于中国医院药品统计报告(CHPA)计算的,反映我国阿片类镇痛药物治疗中、重度疼痛消耗充分性的ACM值,从2006年的0.003 4上-升到2016年的0.010 2,国际相对水平一直处于“极差”.基于国际麻醉药品管制l局(INCB)统计数据计算的ACM值,从2006年的0.0049上升到2013年的0.01 16(国际相对水平仍为“极差”),后持续走低.结论:我国阿片类镇痛药物治疗中、重度疼痛消耗虽然一直在增长,但整体消耗不足,与国际消耗水平有较大差距,存在医务人员、患者、监管体系和社会文化等多层面的原因.应从加强医务人员培训和患者教育,通过大众媒体传播疼痛管理的正确科学理念,鼓励医患间交流与沟通,完善特殊药品监管体系,改进医疗卫生体制,平衡严格监管、防止滥用的目标与满足人民不断增长的对美好生活需要的目标等方面改进.

Objective To analyze impacts of the referral system on outpatient satisfaction with the background of developing a hierarchical medical system, and to provide recommendations for further improvements of the referral system.Methods Based on the outpatient satisfaction survey results of the National Healthcare Improvement Initiative Third Party Assessment(2016-2017),the propensity matching method was used to analyze the satisfaction of outpatients who were referred and not referred.Results Compared with the overall satisfaction score of the non-referred outpatients, that of the referred outpatients was 0.11 points lower(P<0.01,95%CI=-0.17, -0.06).The patient experience satisfaction score of the referred outpatients was 0.06 points lower than that of the non-referred(P=0.03,95%CI=-0.11,-0.01).Conclusions Under the policy background of the hierarchical medical system in China, the current referral system has failed to positively improve patient satisfaction.To further improve the referral system and to raise patient satisfaction,there is a need to take following actions,to link the referral system construction with the public hospital reforms, in order to motivate the tertiary hospitals to be more actively involved in the strengthening of the referral system,to strengthen the medical capacity of the primary health care institutions, to standardize the referral criteria and procedure, and to formulate a more rational and effective health insurance payment method and reimbursement system.In addition, it is critical to further regulate and optimize the referral procedures,so as to set up reasonable and effective insurance payment and reimbursement for the referred patients, to promote the dissemination and to raise public awareness of the referral policy.Finally,it is necessary to enhance the diagnostic and treatment skills of the primary level of the health care delivery system.